Therapy In The Home (Natural Environment)

What is the natural environment, and why does it matter?

Imagine learning to drive in a car racing arcade machine. After you earn a high score, you're immediately handed a driver's license and put on the road in a real car. How do you think you'd do? Fortunately, that's not how we get our license — but it's sometimes how therapy in a clinical setting can feel. Children are often put through simulated situations in a controlled environment, usually a therapy gym or clinic. When they "perform well", they're deemed ready to cope with all of life's challenges. But are they really ready?

Now imagine a considerate instructor who comes to your home, teaches you in your own car, guides you through your neighbourhood car park, drives with you to places you frequent, and even invites your family and friends along to add real pressure and distraction. Sounds like a better, more realistic way to learn? That's essentially therapy in a natural environment.

A child's natural environment consists of the settings where daily activities happen — home, school, community spaces, and even public transport (Hanft & Kristine, 2000). These are the places where families perform everyday tasks and where natural social interactions occur. A controlled environment, in contrast, is one where children learn skills through carefully planned experiences. Many children do need to start there — but conducting therapy in the natural environment offers powerful advantages.

Places in the natural environment

Participation in naturally occurring activities in their rightful environment provides valuable learning opportunities (Dunst et al., 2001). Yet research consistently shows that children with developmental delays engage and interact less frequently with objects and people in shared spaces than their typically developing peers — meaning they may miss out on everyday chances to learn.

Take the playground: it's actually pretty awesome. Swings, slides and monkey bars each provide different learning opportunities — maintaining balance, playing and socialising with peers. If a child can greet, converse and play calmly in a clinic once a week for 45 minutes, does that guarantee they can do the same with family and in the community? Perhaps. But if therapy happens in the specific places they struggle in, and is practised frequently through coaching, children may reach those skills more quickly and thrive in everyday places.

People in the natural environment

If a therapist only works with the child, studies show families are not given adequate support on how to maximise the child's development (Baker et al., 2012; Simpson, 2015). The people who spend the most time in a child's natural environment are their families. Children learn best by watching how their families interact and do things — they want to grow up to be just like you. So the best thing a therapist can do is promote the child's participation in family and community life through family-centred practice.

Family-centred practice in the natural environment is also less disruptive, because it's built into daily routines and supports the whole family as they go about everyday activities (Moore, 2016). Priorities are addressed through collaboration and shared decision-making, leading to more relevant therapy, more opportunities to practise, and better outcomes.

In summary

Little Marvels believes in practising in the natural environment because it means:

• Easy transfer of skills to everyday places. Most life skills are best learnt where they're used — tolerating noise in a quiet clinic is very different from tolerating noise at a busy playground. We want to practise on the real road, not just in the arcade.
• Family-centred practice. Therapy in the natural environment lets therapists observe a family's real routines and coach caregivers directly, so new strategies are applied in real life. We want to work with everyone who's going to be in the car.

To do this, our occupational therapists may conduct a routines-based interview, work closely with you to prioritise your goals, and see your child at home, school, or the community playground — even accompanying the family on special outings when your child struggles with repeated issues.